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Hou M, Wu Y, Xue J, Chen Q, Zhang Y, Zhang R, Yu L, Wang J, Zhou Z, Li X. A predictive model for readmission within 1-year post-discharge in patients with schizophrenia. BMC Psychiatry 2024; 24:573. [PMID: 39174919 PMCID: PMC11340171 DOI: 10.1186/s12888-024-06024-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 08/16/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Schizophrenia is a pervasive and severe mental disorder characterized by significant disability and high rates of recurrence. The persistently high rates of readmission after discharge present a serious challenge and source of stress in treating this population. Early identification of this risk is critical for implementing targeted interventions. The present study aimed to develop an easy-to-use predictive instrument for identifying the risk of readmission within 1-year post-discharge among schizophrenia patients in China. METHODS A prediction model, based on static factors, was developed using data from 247 schizophrenia inpatients admitted to the Mental Health Center in Wuxi, China, from July 1 to December 31, 2020. For internal validation, an additional 106 patients were included. Multivariate Cox regression was applied to identify independent predictors and to create a nomogram for predicting the likelihood of readmission within 1-year post-discharge. The model's performance in terms of discrimination and calibration was evaluated using bootstrapping with 1000 resamples. RESULTS Multivariate cox regression demonstrated that involuntary admission (adjusted hazard ratio [aHR] 4.35, 95% confidence interval [CI] 2.13-8.86), repeat admissions (aHR 3.49, 95% CI 2.08-5.85), the prescription of antipsychotic polypharmacy (aHR 2.16, 95% CI 1.34-3.48), and a course of disease ≥ 20 years (aHR 1.80, 95% CI 1.04-3.12) were independent predictors for the readmission of schizophrenia patients within 1-year post-discharge. The area under the curve (AUC) and concordance index (C-index) of the nomogram constructed from these four factors were 0.820 and 0.780 in the training set, and 0.846 and 0.796 for the validation set, respectively. Furthermore, the calibration curves of the nomogram for both the training and validation sets closely approximated the ideal diagonal line. Additionally, decision curve analyses (DCAs) demonstrated a significantly better net benefit with this model. CONCLUSIONS A nomogram, developed using pre-discharge static factors, was designed to predict the likelihood of readmission within 1-year post-discharge for patients with schizophrenia. This tool may offer clinicians an accurate and effective way for the timely prediction and early management of psychiatric readmissions.
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Affiliation(s)
- Mingru Hou
- Department of General Psychiatry, The Affiliated Mental Health Center of Jiangnan University, Wuxi, Jiangsu, 214151, China
| | - Yuqing Wu
- Department of Psychiatry, The Affiliated Mental Health Center of Jiangnan University, Wuxi, Jiangsu, 214151, China
| | - Jianhua Xue
- Health Screening Center, Shanghai Health and Medical Center, Wuxi, Jiangsu, 214065, China
| | - Qiongni Chen
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Yan Zhang
- Department of Nursing, The Affiliated Mental Health Center of Jiangnan University, Wuxi, Jiangsu, 214151, China
| | - Ruifen Zhang
- Department of Geriatric Psychiatry, The Affiliated Mental Health Center of Jiangnan University, Wuxi, Jiangsu, 214151, China
| | - Libo Yu
- Department of Substance Dependence, The Affiliated Mental Health Center of Jiangnan University, Wuxi, Jiangsu, 214151, China
| | - Jun Wang
- Department of Clinical Psychology, The Affiliated Mental Health Center of Jiangnan University, Wuxi, Jiangsu, 214151, China.
| | - Zhenhe Zhou
- Department of Psychiatry, The Affiliated Mental Health Center of Jiangnan University, Wuxi, Jiangsu, 214151, China.
| | - Xianwen Li
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, 211166, China.
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Lebrat M, Megard R, Dananché C, Zimmer L, Plasse J, Franck N. Identification of factors associated with hospitalization in an outpatient population with mental health conditions: a case-control study. Front Psychiatry 2024; 15:1341160. [PMID: 38699458 PMCID: PMC11063375 DOI: 10.3389/fpsyt.2024.1341160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/28/2024] [Indexed: 05/05/2024] Open
Abstract
Introduction Addressing relevant determinants for preserved person-centered rehabilitation in mental health is still a major challenge. Little research focuses on factors associated with psychiatric hospitalization in exclusive outpatient settings. Some variables have been identified, but evidence across studies is inconsistent. This study aimed to identify and confirm factors associated with hospitalization in a specific outpatient population. Methods A retrospective monocentric case-control study with 617 adult outpatients (216 cases and 401 controls) from a French community-based care facility was conducted. Participants had an index outpatient consultation between June 2021 and February 2023. All cases, who were patients with a psychiatric hospitalization from the day after the index outpatient consultation and up to 1 year later, have been included. Controls have been randomly selected from the same facility and did not experience a psychiatric hospitalization in the 12 months following the index outpatient consultation. Data collection was performed from electronic medical records. Sociodemographic, psychiatric diagnosis, historical issues, lifestyle, and follow-up-related variables were collected retrospectively. Uni- and bivariate analyses were performed, followed by a multivariable logistic regression. Results Visit to a psychiatric emergency within a year (adjusted odds ratio (aOR): 13.02, 95% confidence interval (CI): 7.32-23.97), drug treatment discontinuation within a year (aOR: 6.43, 95% CI: 3.52-12.03), history of mental healthcare without consent (aOR: 5.48, 95% CI: 3.10-10.06), medical follow-up discontinuation within a year (aOR: 3.17, 95% CI: 1.70-5.95), history of attempted suicide (aOR: 2.50, 95% CI: 1.48-4.30) and unskilled job (aOR: 0.26, 95% CI: 0.10-0.65) are the independent variables found associated with hospitalization for followed up outpatients. Conclusions Public health policies and tools at the local and national levels should be adapted to target the identified individual determinants in order to prevent outpatients from being hospitalized.
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Affiliation(s)
- Matthieu Lebrat
- Pôle Centre Rive Gauche, CH Le Vinatier, Bron, France
- Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Rachel Megard
- Pôle Centre Rive Gauche, CH Le Vinatier, Bron, France
| | | | - Luc Zimmer
- Université Claude Bernard Lyon 1, Villeurbanne, France
- UMR 5992 CNRS, U1028 INSERM, Centre de Recherche en Neurosciences de Lyon, Bron, France
- Hospices Civils de Lyon, Lyon, France
| | - Julien Plasse
- UMR 5229 CNRS, Centre Ressource de Réhabilitation psychosociale, Le Vinatier, Bron, France
| | - Nicolas Franck
- Pôle Centre Rive Gauche, CH Le Vinatier, Bron, France
- Université Claude Bernard Lyon 1, Villeurbanne, France
- UMR 5229 CNRS, Centre Ressource de Réhabilitation psychosociale, Le Vinatier, Bron, France
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Lin TC, Lin CH. Schizophrenia Patients Discharged on Clozapine Plus Long-Acting Injectable Antipsychotics From a Public Psychiatric Hospital in Taiwan, 2006-2021. Int J Neuropsychopharmacol 2023; 26:808-816. [PMID: 37616565 PMCID: PMC10674076 DOI: 10.1093/ijnp/pyad053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/21/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Some schizophrenia patients treated with clozapine experience an inadequate response and adherence problems. The purpose of this study was to compare time to rehospitalization within 6 months in schizophrenia patients discharged on 3 clozapine regimens. Additionally, the temporal trend of prescription rate in each group was also explored. METHODS Schizophrenia patients discharged from the study hospital from January 1, 2006, to December 31, 2021, (n = 3271) were included in the analysis. The type of clozapine prescribed at discharge was divided into 3 groups: clozapine plus long-acting injectable antipsychotics (clozapine + LAIs), clozapine plus other oral antipsychotics (clozapine + OAPs), and clozapine monotherapy. Survival analysis was used to compare time to rehospitalization within 6 months after discharge among the 3 groups. The temporal trend in the prescription rate of each group was analyzed using the Cochran-Armitage Trend test. RESULTS Patients discharged on clozapine + LAIs had a significantly longer time to rehospitalization than those on clozapine + OAPs or clozapine monotherapy. The prescription rates of clozapine + LAIs and clozapine + OAPs significantly increased over time, whereas the prescription rates of clozapine monotherapy significantly decreased. CONCLUSIONS Compared with the clozapine + OAPs group, the clozapine + LAIs group had a lower risk of rehospitalization and a lower dose of clozapine prescribed. Therefore, if a second antipsychotic is required for patients who are taking clozapine alone, LAIs should be considered earlier.
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Affiliation(s)
- Ta-Chun Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ching-Hua Lin
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
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Peters SJ, Schmitz-Buhl M, Karasch O, Zielasek J, Gouzoulis-Mayfrank E. Determinants of compulsory hospitalisation at admission and in the course of inpatient treatment in people with mental disorders-a retrospective analysis of health records of the four psychiatric hospitals of the city of Cologne. BMC Psychiatry 2022; 22:471. [PMID: 35836146 PMCID: PMC9284734 DOI: 10.1186/s12888-022-04107-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND We aimed to identify differences in predictors of involuntary psychiatric hospitalisation depending on whether the inpatient stay was involuntary right from the beginning since admission or changed from voluntary to involuntary in the course of in-patient treatment. METHODS We conducted an analysis of 1,773 mental health records of all cases treated under the Mental Health Act in the city of Cologne in the year 2011. 79.4% cases were admitted involuntarily and 20.6% were initially admitted on their own will and were detained later during the course of in-patient stay. We compared the clinical, sociodemographic, socioeconomic and environmental socioeconomic data (ESED) of the two groups. Finally, we employed two different machine learning decision-tree algorithms, Chi-squared Automatic Interaction Detection (CHAID) and Random Forest. RESULTS Most of the investigated variables did not differ and those with significant differences showed consistently low effect sizes. In the CHAID analysis, the first node split was determined by the hospital the patient was treated at. The diagnosis of a psychotic disorder, an affective disorder, age, and previous outpatient treatment as well as the purchasing power per 100 inhabitants in the living area of the patients also played a role in the model. In the Random Forest, age and the treating hospital had the highest impact on the accuracy and decrease in Gini of the model. However, both models achieved a poor balanced accuracy. Overall, the decision-tree analyses did not yield a solid, causally interpretable prediction model. CONCLUSION Cases with detention at admission and cases with detention in the course of in-patient treatment were largely similar in respect to the investigated variables. Our findings give no indication for possible differential preventive measures against coercion for the two subgroups. There is no need or rationale to differentiate the two subgroups in future studies.
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Affiliation(s)
- Sönke Johann Peters
- LVR Institute for Healthcare Research, Wilhelm-Griesinger-Strasse 23, 51109 Cologne, Germany ,grid.411097.a0000 0000 8852 305XUniversity Hospital of Cologne, Cologne, Germany
| | - Mario Schmitz-Buhl
- LVR Clinics Cologne, Wilhelm-Griesinger-Strasse 23, 51109 Cologne, Germany
| | - Olaf Karasch
- LVR Institute for Healthcare Research, Wilhelm-Griesinger-Strasse 23, 51109 Cologne, Germany
| | - Jürgen Zielasek
- LVR Institute for Healthcare Research, Wilhelm-Griesinger-Strasse 23, 51109 Cologne, Germany ,grid.411327.20000 0001 2176 9917Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Euphrosyne Gouzoulis-Mayfrank
- LVR Institute for Healthcare Research, Wilhelm-Griesinger-Strasse 23, 51109, Cologne, Germany. .,LVR Clinics Cologne, Wilhelm-Griesinger-Strasse 23, 51109, Cologne, Germany.
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Olmos MAP, Duque CC, Olmos TP, Duarte RA. Determination of factors associated with early readmission of patients with mental illness in two cities in Colombia during 2018. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2022; 51:176-182. [PMID: 36075854 DOI: 10.1016/j.rcpeng.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/02/2020] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Early rehospitalisation in mental health units (SMHUs) is when a patient needs to be readmitted in the first 30 days after receiving discharge, and is mainly due to recurrent decompensation of their mental illness. This phenomenon is related to a worse prognosis and has an impact on the family, social and work environment. Absenteeism from work and additional hospital time are expenses for the health and employment system which have made rehospitalisation a phenomenon of special interest. The present study was carried out with the objective of exploring the factors associated with the readmission of patients with psychiatric illnesses treated in two MHUs during 2018, as well as those modifiable factors that act as protection for this condition. METHODS Observational, descriptive study with analytical component of cases and controls in two MHUs in different cities of Colombia. Information was obtained by collecting data from the medical records of patients who were admitted between 1 January 2018 and 31 December 2018. The data were collected between 20 February and 27 May 2019. The sample was composed of all the patients who met the criteria for early readmission in both institutions. The study group consisted of 113 patients: (28 cases and 85 controls), matched by by the variables: age, sex, place of hospitalisation and diagnosis. RESULTS In the two hospital MHUs the diagnoses found were: depression (15.5%), bipolar affective disorder (33.1%) and schizophrenia (37.3%). In Bogotá, the most prevalent was depression (31.1%) and, in Tunja, it was schizophrenia (44.8%). For both institutions, the factor most associated with readmission was alcohol consumption, but other variables of treatment, family nucleus, and individual intervention were also associated with a greater probability of early readmission. CONCLUSIONS It was possible to demonstrate that the use of atypical and/or depot antipsychotics, hospitalisations longer than 15 days, and prescriptions of less than three drugs at discharge, reduce the number of early readmissions to MHUs.
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Lin CH, Chan HY, Wang FC, Hsu CC. Time to rehospitalization in involuntarily hospitalized individuals suffering from schizophrenia discharged on long-acting injectable antipsychotics or oral antipsychotics. Ther Adv Psychopharmacol 2022; 12:20451253221079165. [PMID: 35340566 PMCID: PMC8949740 DOI: 10.1177/20451253221079165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/14/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Involuntarily hospitalized individuals suffering from schizophrenia often have a poorer prognosis after discharge. OBJECTIVE This study aimed to analyze time to rehospitalization within 6 months of discharge in involuntarily hospitalized individuals suffering from schizophrenia discharged on long-acting injectable antipsychotics (LAIs) or oral antipsychotics (OAPs). In addition, temporal trends in LAI use at discharge were explored. METHODS Involuntarily hospitalized individuals suffering from schizophrenia discharged from the study hospital between 2006 and 2019 (n = 806) were included in the analysis. Survival analysis was used to compare time to rehospitalization within 6 months of discharge between individuals discharged on LAIs and OAPs, and between first-generation antipsychotic (FGA) LAIs and second-generation antipsychotic (SGA) LAIs. The Cochran-Armitage trend test was used to test whether a temporal trend existed for LAIs use at discharge during the study period. RESULTS The LAIs group (n = 231) had a significantly lower rate of rehospitalization and a significantly longer time to rehospitalization than the OAPs group (n = 575). Rehospitalization rate and time to rehospitalization were not significantly different between individuals discharged on FGA-LAIs and SGA-LAIs. LAIs use at discharge grew significantly from 16.77% in 2006 to 50.00% in 2019 (Z = 6.81, p < 0.0001). Among all LAIs, only use of SGA-LAIs at discharge increased significantly (Z = 5.74, p < 0.0001), but not FGA-LAIs. CONCLUSIONS LAIs were superior to OAPs in preventing rehospitalization. However, SGA-LAIs were comparable with FGA-LAIs in reducing rehospitalization risk. Use of LAIs increased significantly in discharged involuntarily hospitalized individuals during the study period, especially SGA-LAIs.
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Affiliation(s)
- Ching-Hua Lin
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung
| | - Hung-Yu Chan
- Department of General Psychiatry, Taoyuan Psychiatric Center, No. 71, Long-Show Street, Taoyuan City 33058
| | - Fu-Chiang Wang
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung
| | - Chun-Chi Hsu
- Department of General Psychiatry, Taoyuan Psychiatric Center, Taoyuan City
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Olmos MAP, Duque CC, Olmos TP, Duarte RA. Determination of Factors Associated with Early Readmission of Patients with Mental Illness in Two Cities in Colombia During 2018. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2021; 51:S0034-7450(20)30119-0. [PMID: 33735043 DOI: 10.1016/j.rcp.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/02/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Early rehospitalisation in mental health units (SMHUs) is when a patient needs to be readmitted in the first 30 days after receiving discharge, and is mainly due to recurrent decompensation of their mental illness. This phenomenon is related to a worse prognosis and has an impact on the family, social and work environment. Absenteeism from work and additional hospital time are expenses for the health and employment system which have made rehospitalisation a phenomenon of special interest. The present study was carried out with the objective of exploring the factors associated with the readmission of patients with psychiatric illnesses treated in two MHUs during 2018, as well as those modifiable factors that act as protection for this condition. METHODS Observational, descriptive study with analytical component of cases and controls in two MHUs in different cities of Colombia. Information was obtained by collecting data from the medical records of patients who were admitted between 1 January 2018 and 31 December 2018. The data were collected between 20 February and 27 May 2019. The sample was composed of all the patients who met the criteria for early readmission in both institutions. The study group consisted of 113 patients: (28 cases and 85 controls), matched by by the variables: age, sex, place of hospitalisation and diagnosis RESULTS: In the two hospital MHUs the diagnoses found were: depression (15.5%), bipolar affective disorder (33.1%) and schizophrenia (37.3%). In Bogotá, the most prevalent was depression (31.1%) and, in Tunja, it was schizophrenia (44.8%). For both institutions, the factor most associated with readmission was alcohol consumption, but other variables of treatment, family nucleus, and individual intervention were also associated with a greater probability of early readmission. CONCLUSIONS It was possible to demonstrate that the use of atypical and/or depot antipsychotics, hospitalisations longer than 15 days, and prescriptions of less than three drugs at discharge, reduce the number of early readmissions to MHUs.
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de Jong MH, Wierdsma AI, Zoeteman J, van Boeijen CA, Van Gool AR, Mulder CL. Risk factors for repeated emergency compulsory psychiatric admissions. BJPsych Open 2020; 7:e19. [PMID: 33349278 PMCID: PMC7791558 DOI: 10.1192/bjo.2020.153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The characteristics of patients who have repeated compulsory psychiatric admissions are largely unknown. AIMS To investigate the frequency and risk factors for repeated emergency compulsory psychiatric admission (ECPA); and to identify targets for interventions to reduce repeated ECPA. METHOD Data were collected from a database of electronic patient files (EPFs) held by three psychiatric emergency services (PES) in the Netherlands. Analyses were based on the data for adult patients (aged 18-75 years) with a first PES contact in 2010-2015. Using descriptive statistics and regression analysis, we studied the associations between baseline patient factors and repeated ECPA and time to readmission, within a 2-year follow-up period. RESULTS We included 6059 patients: 15.6% had two or more ECPAs. In total, 66% of second ECPAs had occurred within 6 months of the first. About 30% of all ECPAs were repeated ECPAs. Two baseline factors were associated with a higher frequency of a second ECPA: history of receiving any mental healthcare treatment, whether in-patient or out-patient or both, and a lower level of self-care. Three were associated with a lower frequency: ethnicity (other than Dutch), older age and suicidality. Lower Global Assessment of Functioning (GAF) scores and housing problems were associated with a shorter time to compulsory readmission and persistent psychiatric problems with a longer time to compulsory readmission. CONCLUSIONS We found that 15.6% of patients had two or more ECPAs. Two-thirds of the second ECPAs had occurred within 6 months of the first. Like earlier studies, the risk factors we identified suggest that interventions to reduce the risk of repeated compulsory psychiatric admission should seek to improve self-care, general daily functioning and homelessness.
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Affiliation(s)
| | - André I Wierdsma
- Epidemiological and Social Psychiatric Research Institute (ESPRi), Department of Psychiatry, Erasmus University Medical Centre, the Netherlands
| | | | | | | | - Cornelis L Mulder
- Epidemiological and Social Psychiatric Research Institute (ESPRi), Department of Psychiatry, Erasmus University Medical Centre, the Netherlands
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Silva M, Antunes A, Loureiro A, Azeredo-Lopes S, Saraceno B, Caldas-de-Almeida JM, Cardoso G. Factors associated with length of stay and readmission in acute psychiatric inpatient services in Portugal. Psychiatry Res 2020; 293:113420. [PMID: 32861099 DOI: 10.1016/j.psychres.2020.113420] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 11/20/2022]
Abstract
Assessing the factors that influence duration and number of hospitalizations may support mental health services planning and delivery. This study examines the factors associated with length of stay and readmission in Portuguese psychiatric inpatient services during 2002, 2007 and 2012. Data from all admissions were extracted from clinical files. Logistic regression models estimated the association between length of stay (<17 vs ≥17 days) and number of admissions per year (1 vs >1 admission) with sociodemographic, clinical, and contextual factors. Older age, a diagnosis of psychosis, and compulsory admission were associated with higher odds of longer length of stay. Being married, secondary education, suicide attempt, a diagnosis of substance use and "other mental disorders", being admitted in 2012, and two of the psychiatric inpatient services associated with lower odds of longer length of stay. Being retired (or others), a diagnosis of psychosis, compulsory admission, and psychiatric service were associated with increased odds of readmission. Older age, and secondary and higher education were associated with lower odds of readmission. The findings indicate that multiple factors influence length of stay and readmission. Identifying these factors provides useful evidence for clinicians and policy makers to design more targeted and cost-effective interventions.
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Affiliation(s)
- M Silva
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Rua do Instituto Bacteriológico, n°5, 1150-190 Lisbon, Portugal; Lisbon Institute of Global Mental Health, Lisbon, Portugal.
| | - A Antunes
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Rua do Instituto Bacteriológico, n°5, 1150-190 Lisbon, Portugal; Lisbon Institute of Global Mental Health, Lisbon, Portugal.
| | - A Loureiro
- Centre of Studies on Geography and Spatial Planning (CEGOT), Faculty of Arts and Humanities, Coimbra, Portugal
| | - S Azeredo-Lopes
- Nova Medical School, Nova University of Lisbon, Lisbon, Portugal.
| | - B Saraceno
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Rua do Instituto Bacteriológico, n°5, 1150-190 Lisbon, Portugal; Lisbon Institute of Global Mental Health, Lisbon, Portugal
| | - J M Caldas-de-Almeida
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Rua do Instituto Bacteriológico, n°5, 1150-190 Lisbon, Portugal; Lisbon Institute of Global Mental Health, Lisbon, Portugal
| | - G Cardoso
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Rua do Instituto Bacteriológico, n°5, 1150-190 Lisbon, Portugal; Lisbon Institute of Global Mental Health, Lisbon, Portugal
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Yang Y, Li W, Lok KI, Zhang Q, Hong L, Ungvari GS, Bressington DT, Cheung T, Xiang YT. Voluntary admissions for patients with schizophrenia: A systematic review and meta-analysis. Asian J Psychiatr 2020; 48:101902. [PMID: 31896433 DOI: 10.1016/j.ajp.2019.101902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/19/2019] [Accepted: 12/13/2019] [Indexed: 10/25/2022]
Abstract
AIMS Voluntary admission rates of schizophrenia vary widely across studies. In order to make the topic be informed by evidence, it is important to have accurate estimates. This meta-analysis examined the worldwide prevalence of voluntary admissions for patients with schizophrenia. METHOD PubMed, EMBASE, PsycINFO, the Cochrane Library, Web of Science and Medline databases were systematically searched, from their commencement date until 19th November 2018. Meta-analysis of included studies was performed using the random-effects model. RESULTS Thirty-five studies with 134,100 schizophrenia patients were included. The overall voluntary admission rate of schizophrenia was 61.9 % (95 %CI: 52.3 %-70.7 %), while the involuntary rate was 43.0 % (95 %CI: 34.8 %-51.7 %). Subgroup analyses revealed that patients in Europe had significantly higher voluntary admission rates, while their North American counterparts were more likely admitted involuntarily. Papers published prior to 2008 reported higher involuntary admission rates. Meta-regression analyses showed that higher male percentage and higher study quality were significantly associated with higher voluntary admission rate. CONCLUSION Although the worldwide prevalence of voluntary admissions was higher than that of involuntary admissions, the latter was common for schizophrenia. With the continuing liberalization of mental health laws broadening community-based psychiatric services, the rate of voluntary psychiatric admissions is expected to further increase over time.
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Affiliation(s)
- Yuan Yang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macau; Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangdong, China
| | - Wen Li
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macau
| | - Ka-In Lok
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macau
| | - Qinge Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Liu Hong
- Department of Psychiatry and Mental Health, Guangdong Medical University, Guangdong, China; Department of Psychiatry, Shunde WuZhongpei Memorial Hospital, Foshan, Guangdong, China
| | - Gabor S Ungvari
- University of Notre Dame Australia, Fremantle, Australia; Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Australia
| | | | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macau.
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Walker S, Mackay E, Barnett P, Sheridan Rains L, Leverton M, Dalton-Locke C, Trevillion K, Lloyd-Evans B, Johnson S. Clinical and social factors associated with increased risk for involuntary psychiatric hospitalisation: a systematic review, meta-analysis, and narrative synthesis. Lancet Psychiatry 2019; 6:1039-1053. [PMID: 31777340 PMCID: PMC7029280 DOI: 10.1016/s2215-0366(19)30406-7] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Use of involuntary psychiatric hospitalisation varies widely within and between countries. The factors that place individuals and populations at increased risk of involuntary hospitalisation are unclear, and evidence is needed to understand these disparities and inform development of interventions to reduce involuntary hospitalisation. We did a systematic review, meta-analysis, and narrative synthesis to investigate risk factors at the patient, service, and area level associated with involuntary psychiatric hospitalisation of adults. METHODS We searched MEDLINE, PsycINFO, Embase, and the Cochrane Controlled Clinical Register of Trials from Jan 1, 1983, to Aug 14, 2019, for studies comparing the characteristics of voluntary and involuntary psychiatric inpatients, and studies investigating the characteristics of involuntarily hospitalised individuals in general population samples. We synthesised results using random effects meta-analysis and narrative synthesis. Our review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and is registered on PROSPERO, CRD42018095103. FINDINGS 77 studies were included from 22 countries. Involuntary rather than voluntary hospitalisation was associated with male gender (odds ratio 1·23, 95% CI 1·14-1·32; p<0·0001), single marital status (1·47, 1·18-1·83; p<0·0001), unemployment (1·43, 1·07-1·90; p=0·020), receiving welfare benefits (1·71, 1·28-2·27; p<0·0001), being diagnosed with a psychotic disorder (2·18, 1·95-2·44; p<0·0001) or bipolar disorder (1·48, 1·24-1·76; p<0·0001), and previous involuntary hospitalisation (2·17, 1·62-2·91; p<0·0001). Using narrative synthesis, we found associations between involuntary psychiatric hospitalisation and perceived risk to others, positive symptoms of psychosis, reduced insight into illness, reduced adherence to treatment before hospitalisation, and police involvement in admission. On a population level, some evidence was noted of a positive dose-response relation between area deprivation and involuntary hospitalisation. INTERPRETATION Previous involuntary hospitalisation and diagnosis of a psychotic disorder were factors associated with the greatest risk of involuntary psychiatric hospitalisation. People with these risk factors represent an important target group for preventive interventions, such as crisis planning. Economic deprivation on an individual level and at the population level was associated with increased risk for involuntary hospitalisation. Mechanisms underpinning the risk factors could not be identified using the available evidence. Further research is therefore needed with an integrative approach, which examines clinical, social, and structural factors, alongside qualitative research into clinical decision-making processes and patients' experiences of the detention process. FUNDING Commissioned by the Department of Health and funded by the National Institute of Health Research (NIHR) via the NIHR Mental Health Policy Research Unit.
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Affiliation(s)
- Susan Walker
- Division of Psychiatry, University College London, London, UK; Great Ormond Street Institute of Child Health, University College London, London, UK.
| | - Euan Mackay
- Department of Clinical Educational and Health Psychology, Centre for Outcomes Research and Effectiveness, University College London, London, UK
| | - Phoebe Barnett
- Department of Clinical Educational and Health Psychology, Centre for Outcomes Research and Effectiveness, University College London, London, UK
| | - Luke Sheridan Rains
- Division of Psychiatry, University College London, London, UK; National Institute of Health Research Mental Health Policy Research Unit, University College London, London, UK
| | - Monica Leverton
- Division of Psychiatry, University College London, London, UK
| | - Christian Dalton-Locke
- Division of Psychiatry, University College London, London, UK; National Institute of Health Research Mental Health Policy Research Unit, University College London, London, UK
| | - Kylee Trevillion
- National Institute of Health Research Mental Health Policy Research Unit, University College London, London, UK; Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Brynmor Lloyd-Evans
- Division of Psychiatry, University College London, London, UK; National Institute of Health Research Mental Health Policy Research Unit, University College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK; National Institute of Health Research Mental Health Policy Research Unit, University College London, London, UK
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